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報告人： PGY夏紹剛 Email:143920@cch.org.tw 指導臨床教師：何昌益醫師/謝堯棚醫師 日期：2009/10/29 地點：一般內科82討論室 Clinical Scenario （臨床情境） 個案為73歲已婚男性，有高血壓及糖尿病病史，右腳糖尿病足於97年9月接受高壓氧治療後痊癒，本次因雙足潰瘍已兩週入院，診斷為糖尿病足，右足壞疽嚴重經外科清瘡治療後，外科醫師建議植皮以加速復原，病人僅希望再次進行高壓氧治療不願植皮。?? Clinical Uncertainty → PICO 問題 對於糖尿病足部潰瘍患者，單純接受高壓氧治療相較於植皮是否仍有理想的復原能力？ 臨床個案的PICO Patient / Problem Patient who has Type 2 DM with foot ulcers (foot ulcer or diabetic foot) Intervention HBO OR hyperbaric oxygenation Comparison skin graft or skin transplantation Outcome enhance the wound healing Type of Question: Therpy Search Terms Strategy: （搜尋關鍵字與策略） 資料庫： Pubmed 搜尋日期： 2009/10/23 搜尋關鍵字與隅策略： 如圖表 Best available evidence:（挑選可獲得之最佳研究證據） Citation/s: A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes(2008) Lead authors name : R.J.Hinchliffe, G.D.Valk, J.Apelqvist, D.G.Armstrong, K.Bakker, F.L.Game, A.Hartemann-Heurtier, M.Londahl, P.E.Price, W.H.van Houtum,W. J.Jeffcoate The Study: （研究效度）- 1 Prospective and retrospective controlled studies, published in any language, that evaluated interventions for the treatment of chronic foot ulcers in people aged 18 years or older with either type 1 or type 2 diabetes mellitus were considered. Randomized controlled trials (RCTs), case-control studies, prospective and retrospective cohort studies, control before-and-after (CBA) design and interrupted time series (ITS) designs were included. MEDLINE (1966 - 2006)EMBASE(1980 - 2006) The Cochrane database of systematic reviews, and the Cochrane Central Controlled Trials Register (2006) The Study: （研究效度）- 2 One reviewer assessed all identified references by title and abstract on the basis of patient group, intervention and outcome. Full paper copies of identified articles were then assessed for eligibility by two independent reviewers (agreement was reached). Each included paper was further assessed by two reviewers, working independently, and information was extracted on study desig